Toxicology and Pharmacology Flashcards
What blood picture on a gas do you see in Aspirin OD
Metabolic alkalosis initially
What Juice does Warfarin Interact with
Cranberry Juice
What juice does Statin and Ciclospoin interact with the most
Grape Juice
What HLA type is S-J syndrome associated with
HLA-B1502
What is the best Mx of Neuroleptic Malignant Syndrome
IV fluids
Dopamine Agonist -Bromocriptine
What are the features of Local Anesthetic Toxicity
SAMS ( Slurred speech, Altered Mental Status, Muscle Twitching, Seizures)
Peri-oral tingling and numbness can also happen
Mx: 20% Lipid Emulsion ( Stat Followed by Infusion)
What are the key features of Ecstasy Toxicity
Hyperpyrexia
Rhabdomylosis
Kidney disease
Liver Failure
HTN
MX:
Benzodiazepine - agitation
IV fluids - Rhabdomylosis
IV Sodium Nitroprusside - HTN
Proximal myopathy with sensory neuropathy in someone being treated for gout.
What is the cause
Colchicine side effects
Note: Serum Creat Phosphokinase can be normal or elevated
Note:
Once drug is stopped, myopathy resolves, but sensory neuropathy remains
what is a note on PCM and Cyt. p450 inducers
Incudes worsen the effects of PCM as PCM gets metabolised and its metabolite NAPQI affects liver
What drug can cause Myasthenia Gravis
Penicillamine
what is the Mx of Paraqaut poisoning
Activated charcoal
Ideally witting 2 hrs, but effective within first 12 hrs
How do you measure bleeding risk in someone taking rivaroxban
Measuring Factor Xa
(rivaroxoaban is an inhibitor of factor Xa)
High Hb
Small Testes
Normal Axiallary and Pubic hair
What is your Dx
Androgen Abuse
Ix:
Low LH ***
Increases Testosterone : Epitosterone ratio ( >6:1)
What are the drugs causing Increased risk of pancreatitis
5-ASA, Azathioprine, Sodium Valproate, Furosemide, Oestorgen, Corticosteroids, Ocreotide, Metronidazole, Cimetidine, Cisplatin
ACE- side effect
Angioedema
What is the mx of Methahemoglobinameia
1) Methylene Blue
2) Ascorbic Acid
Hypokalemia
Hyperglycemia
Mild acidosis
in someone being treated for COPD
What is your Dx
Theophylline Toxicity
mX:
Multidose activated charcoal
or
Dialysis
Why do steroids cause Hyperglycaemia
Increase Gluconeogensis
What are the key features of neuroleptic malignant syndrome
Rgidity
Fever
Extra-pyramidal signs
Catatonia- Muteness
Increased Creat Phosphokinase
Increased AST
Urine Myoglobin
Which drugs can cause chronic urticaria
Aspirin, NSAID, Opiates
What drug should be stopped when starting azathioprine
Allopurinol
A both azathioprine and allopurinol cause myelosuppression and if used together can cause significant haematological toxicity
What is a normal anion gap
12-16
What anion gap do you see in methanol toxicity
Raised anion gap
with metabolic acidosis Resp compensation
Renal colic
Recent HAART for HIV
Which drug can cause nephrolithiasis
Nelfinavir
How do you Tx Amitriptyline x OD
Sodium Bicarb
Post MI and Angioplasty, If pt.dvelops GI hemorraghe few in first few days and is on aspirin, clopi and Fonda
What do you do
Stop Fonda only
But continue Aspirin and clopi
Note:
If all 3 are stopped, high risk of stent thrombosis
IF Pt. is on Warfarin and now being considered an anti-depreesant
Which would you choose
Mirtazepine
Note: SSRI are contradincatd when ppl on warfarin as they enhance the effect of warfarin
is St. Jhons wart an inducer or inhibitor
Inducer
What is the mx of methanol or ethylene glycol poisoning
Fomepizaole
Note: Both methanol and ethylene glycol poisoning cause raised anion gap with met. acidosis
Note: In methanol poisoning, sometimes you can treat with IV ethanol as well
What group of drug is dothiepin
TCA
What is the side effect of Streptomycin
vestibular damage
What are the side effects of anti-tb drugs
Isoniazid - peripheral neuropathy
( due to Vitamin B6 depletion - Pyridoxine)
Rifampin - Colour change of secretions
Pyrazinamide- Joint pains, arhtraliga
Ethambutol - Optic neuritis
Streptomycin - vestibular damage
What are the key features of TCA Toxicity
Dry mouth
Urinary retention
Skin blistering
Hyperthermia
Ataxia
Nystagmus
Hyper-reflexia
Arrhythmia ( widened QRS complex)
Seizure and coma can occur
Mx: Sodium Bicarb
What are Drug causing gynecomastia
Digoxin
Spironolactone
Ketoconazole
Metronidazole
Finasteride
Why does isoniazid cause peripheral neuropathy
( due to Vitamin B6 depletion - Pyridoxine)
Where do you use
trihexiphenydil Hydrochloride ( Benzhexol)
Mx of Oculogyric crisis
( due to metaclopramide/ prochlorperazine)
What are the key features of
aspirin ( Salicylate) OD
Hyperventilation
Tinnitus
Which anticonvulsant causes irreversible visual field defects
Vigabatrin
How do you correct Torsades De Pointes
IV Mg Sulphate x 10mmol over 15 mins
How do you treat Pt.;s with beta blocker over dose where there is bradycardia and hypoglycaemia
1st- IV glucagon
2nd - If no response, then for pacing
How do you treat salicylate poisoning
1.26% of Sodium Bicarbonate
If severe complications, then dialysis
what is the relation of TMPT and Azathioprine
Low or absence of TMPT, leads to excess cumulation of azathioprine levels and causes toxicity as it isn’t metabolised
Which anti-HTN drugs is associated with erectile dysfunction
Beta blockers - such as Atenolol
Switch to cardio-selective beta biker like bisoprolol or nebivolol
What is the mx of lead poisoning
DMSA - Dimercaptosuccinic acid
Calcium edetate
What Is the mx of cyanid poisoning
Dicobalt Edetate x 300mg x IV - 1st
Sodium Thisosulfate - 2nd
NOTE : NOT sodium nitroprusside
Someone with Carbazemine OD, having multiple sizures
How do you Mx
Trial Lorazepam
If fails with lorazepam as well, the intubate and ventilate
Which anti-psychotic drug causes agranulocytosis
Clozapine
What are some of the drugs that cause Methaemoglobinameia
Trimethoprim
Primaquine
Sulphonamides
Lidocaine
Amyl Nitrate
Chloroquine
Dapsone
Metoclopramide
Phenacetin
Anilyn Dyes
What drugs can cause sensorineural deafness
Gentamicin
Vancomycin
Erythromycin
What are the indications to use anti-venom after a snake bite
> Persistent Hypotension
Lower limb oedema ascending 2-4 hrs post snake bite
WBC> 20
ECG abnormalities
Vomiting
Hemostatic changes
Note:
Mere presence of snake bite venpecture does nOT indicate anti-venom use
NOte:
Antivenom use has 1% risk of anaphylaxis
What are the indications for digibind use
> Hemodynamic instability
Life threatening arrhythmias
K >5
Plasma Dig levels >13nmol/l
Ingestion of >10mg of dix for adults and >4mg for children
Recurrent Bradycarida
What is the side effect of bleomycin
Pulm Fibrosis
What is the side effect of daunorubicin
Cardiomyopathy
What can occur with sodium Nitroprusside Overdose
Cyanide accumulation and toxicity
How d you treat drug induced ( Meotclopramide/ Prochlorperazine) dystonia/ truisms/Torticollis/ oculogyric crisis
Procyclidine
What additional test can you do when you are checking for anabolic steroid abuse and the blood test show;
Testoetrone;Epitestostrone radio between 4:1 and 6:1
Carbon 13: Carbon 12 ratio
Note:
if Testosterone : epitestosterone Ratio Is;
>6:1, it automatically confirm anabolic abuse
How can use test for EPO abuse
It can be tested in urine for a few weeks after injection
What is the criteria for Liver Tx in PCM Overdose
If Ph <7.3 or lactate >3 after adequate fluid resus
OR
if all 3 below present in 24 hrs
> Creat >300
> PT >100 ( or INR >6.5)
> Grade III/IV encephalopathy
what is the MOA of Methrotreaxate that causes pancytopenia and megaloblastic anemia
Inhibition of dihydrofolate reductase
Why should you not treat mixed OD of benzodiazepines + TCA or benzodiazepines + Other drugs with flumazenil
It can cause seizures
Paraquat poisoning Ix
1st - urine testing
2nd- If above raised, then confirm with serum levels
How do you reverse Methotrexate toxicity
Folinic Acid/ Calcium Folinate
( Leucovorin)
Note:
Please note, Folinic acid is NOT same a folic acid
Which Anti-HTn is safe to use with Lithium
CCB ( amlodipine)
Note:
ACE/ARB/ Diuretics can worsens toxicity of lithium
what can you use if someone has persistent VT in TCA x OD even after acidosis has been corrected with Sodium Bicarb
IV Lidocaine
What is the advice on thalidomide and family planning
Both sexes need to use contraception
Will be cleared off system 1 week post stopping drug.
When do you use gastric lavage over activated charcoal in Aspirin poisoning
When OD is >500mg/kg
What is the Mx of Serotonin Syndrome
Cryoheptadine and propranolol
How do you treat Iron Overload
Parenteral Desferrioxamine
NOT Oral ( as absorption is minimal to treat Iron Overload)
Features:
Abdo Pain
Vomting
GI blood loss
Xray- show tablets in bowel
Which antiseptic is fairly safe in OD
Sodium Valproate
What are the features of theophylline OD
Arrhythmias
Vomitng
Confusion
Seizures
Electrolyte Changes;
Hypokalaemia
Hyperglycaemia
Hypercalcaemia
MX:
Charcoal Hemoperfusion
What are the key features of GHB overdose
Also called as ;
Liquid X, Easy Lay, Scoop, or GHB, Cherry meth
Used by body builders to gain muscles and lose weight
Tastes like Sea Weed
Pt. can deteriorate rapidly and go into Resp depression and coma
Can Spontaenously recover and even pull out Endo tracheal tubes after being ventilated!!!
Met Acidosis
Hyperglycaemia
Hyperkalemia
Hypernatremia
In which drug over-doses can multiple dose activated charcoal be used
Carbamazepine
Theophylline
Digoxin
Dapsone
Phenobarbitone
Quinine
What are the features of Phenytoin Toxicity
Mental slowing
Ataxia
Cerebellar dysfunction
Nystagmus
What is the Mx of CCB x overdose
Calcium Chloride infusion
High dose insulin dextrose
Atropine if bradycardia and hypotension
What is the Mx of Body packers with drugs
If asymptomatic - Laxatives
If symptomatic - Surgical referral
What is the composition of Fomepizole
4-methypyrazole
Note:
If fomepizole not available in eythylene glycol poisoning and Pt. is acidotic with Ph <7.2 -> give 8.4% sodium bicarbonate
How do steroids use affect/cause osteoporosis
Affect/alter PTH secretion
( reduced tonic secretions and causes more used secretions )
What is the MOA of Phenoxybenzamine
Non competiive; Alpha receptro antagonist
What is the MOA of Prazosin/ Terazosin
competiive; Alpha receptro antagonist
What are th key features of Methanol poisoning
Blurred optic discs
Raised anion gap
Raised osmolar gap
Which anti-rheumatoid drug is your first preference In pregnancy
Sulfazalazine
Azathioprine
But if both in option, Sulfa is better
How do you reduce risk of hemorrghaic cystitis in Cyclophosphamide use
MESNA
Which Abx are safe in pregnancy and breastfeeding
Pencillin, Cephalosporins, Macrolides
What should you monitor when someone is on Azathioprine
FBC, U and E;s and LFT
What I the key in Gent dosing
If trough is high, increase interval
If Peak is high, reduce Dose
How does rifaximin reduce encephalopathy
It reduced ammonia levels
Which antiemetics are safe in pregnancy
Promethazine and Cyclziine
Why does amlodipine cause Hypotension and Tachycardia
L-Type Calcium Blockade
Remember
Am’L’odipne
What is the side effect of Tetracycline in infants
Teeth Staining and impaired bone growth
Which drug can cause Hypertrichosis
Ciclosporin
What is a common interaction of verapamil with
Ciclosporin
What is the 1st line of Mx of serotonin Syndrome
Diazepam
If no response
then Cryohepatidine
Severe hyperthermia during intubation/anestheisa
Raised Pco2
Jaw Spams
Whats is your Dx and MX
Malignant hyperthermia
Mx: Dantrolene
and change anesthetic agent ( possibley to propofol)
Causes:
Halothane, Succinylcholine, Isfolurane
What re the effects of Amphetamine abuse
Similar features like schizophrenia
